Dr Phelan aims in the long-term to become a leader in improving the quality of health services, particularly primary care, for the elderly. Her research to date has combined her interests in health promotion, health care quality, and vulnerable populations and has involved survey methods and analyses of existing data. During the period of this K23 award, she will follow a program of research and training to ensure that she will possess both the skills and the experience to conduct patient orionred research as an independent investigator. Her research and training will be overseen by Dr Edward H. Wagner. Geriatric expertise and academic career guidance will be provided by Dr Itamar B. Abrass. Collaborators/advisors will include Drs Andrea Z. LaCroix and Eric B. Larson; James P. LoGerfo will serve as an advisor. Preserving function and independence is an important health outcome in the care of older adults. Individual (patient) risk factors for functional decline have been intensely studied, as have focused interventions for specific risk factors. However, little is known about the effects of provider practice or practice design features on the functional status of older adults. The proposed research will address these questions. The specific aims are: 1) to evaluate the effect of provider practice style on patient functional status and 2) to evaluate the feasibility and efficacy of integrating a geriatric care team into outpatient, primary care. The proposed projects will be led by the candidate under the supervision of her Sponsor, Dr Wagner. These investigations should contribute new insights into improving primary care of older adults in order to promote continued independent functioning. By permitting Dr Phelan to 1) obtain formal training in advanced epidemiologic and statistical techniques and 2) take a lead role in the conduct of a randomizod trial of a new model of care for primary care settings, the Mentored Patient Orionted Research Career Development Award will enable her to meet her 5-year goal of achieving independent investigator status and move her toward her Iong-term, career goal described above.